Hey man, I don’t “accoucher” – I Midwife

Interesting.

I just came across the meaning of the word accoucher. Funnier still, I came across it while reading one of the last books in the Outlander series on my Kindle. Being the curious little brain I am I asked my device for the definition. It said “male midwife”. Slightly offended after having “accouchered” many births to become a registered midwife, I needed to look further into this. The definition of accoucher ranges from ‘a male midwife’, someone who assists birth “mainly an obstetrician”, associations with ideas like “unburdening” and “delivery”. Female midwives have been known as such since the 1200-1300’s whereas the term accoucher came about in the 1800s. Pretty much around the time male birth attendants became the norm and not long before midwifery practice became outlawed in various locations around the world.

Previously I had thought an accoucher was the primary caregiver directly helping the woman giving birth. It is to an extent but historically it appears that it was introduced as term for male birth attendant but miwives could be included. As a secondary notion of course….

Funny the little rabbit holes we go down and the terms we blindly accept without really considering their origin, meaning or intent. Universities really should avoid using this terminology, especially given the overwhelming majority of its students are female.

🧐 🤔

This is a short one friends. I dont accoucher births. I dont catch babies because they are not something to be thrown. I dont deliver babies because they are not pizza’s. I support women to birth their babies. I am the primary care midwife. Or, plain and simple – I am a midwife. I am with woman ♡

Back to basics and into the dark….

When working in busy fragmented models of care with pressure on time, workload and an increasing amount of paperwork and so on – it can be easy to be pulled along in the current. Get to work, get handover, get a handle on the scene. Building rapport with a family, assessing the situation and going over notes and results. Heaven forbid you slow down for a moment in case you miss some vital piece of information that could potentially lead to the doom of all involved. Yes, it feels like that. What have I missed, what documents guide me on this, how do I find them? Who do I ask?

And then we slow down for a second, we properly meet the woman and her support crew. We truly see them and their baby (in the womb) and realise – all the lights are on and there is not a scrap of privacy in the room for this woman. With the hustle and bustle of midwives and doctors in and out of the room sometimes the absolute fundamentals of holistic midwifery practice get missed. Creating a space that feels, looks and sounds safe and private.

I particularly see this on weekday inductions of labour. Maternity units are in a state of constant flux as their ”business as usual”. Inductions are booked daily, starting the process morning and evening with oxytocin infusions starting and ending all the time. In this almost robotic method of bringing about birth it can become so process focussed and time trapped that it pulls away from the very nature of how birth unfolds. It is still birth! The very things we know about promotion of natural oxytocin are still every bit as relevant for the successful use of synthetic oxytocin. Some would argue even more so to increase the chance for endogenous oxytocin production to catch up and decrease interruption to bonding and the breastfeeding relationship immediately after birth beyond 3 months^2,3. We don’t know a lot about the long term effects of high dose synthetic oxytocin on mothers or babies but a common sense approach applies, the less we need the better. I am not arguing for or against induction of labour in this blog that is a very different subject which someone else has covered well. I align with the thoughts of Dr Rachel Reed on ‘Why Induction Matters’ ¹ which you can find more info in the resources. But back to my point – THE LIGHTS PEOPLE!! TURN OFF THE FRIGGING LIGHTS!!!

As a midwife you learn in detail about the physiology of labour and birth. Fear and adrenaline have an inhibitory effect on endogenous oxytocin production. Being on display when at our most primal, feeling out of control is something that the overwhelming majority of women are NOT comfortable with. Our mammalian brains seek quiet, private space for us to give birth so that we can keep ourselves and our babies safe. But often hospital-based birth spaces are not dark, at best they can be dimly lit. We as midwives NEED to be aware that such a simple act is one which can be incredibly powerful. We need to advocate for relative darkness, promoting a sense of safety and privacy but also creating an environment to enhance the natural flow of melatonin and oxytocin and the cascade of helpful hormones will follow.

What is less known is the importance of the hormone melatonin in labour. Melatonin is the hormone of darkness, released from the pineal gland and works synergistically with oxytocin. In fact melatonin and oxytocin receptors are collocated in the central nervous system⁴. The functional triad of oxytocin-GABA-melatonin inhibits neocortical activity⁵ which in turn enhances potential for contractility of uterine muscle.  This hormone usually begins synthesis and secretion from the onset of darkness, reaching its peak between 2 and 4am⁵. It is one of the reasons women usually go into labour at night or in the early hours of the morning.  What we know about the release of melatonin is that it is affected by the sense of sight and is inhibited by intensity and length of exposure to light via increased neocortical activity⁶ (coherence, talking, problem solving state etc). Think about how much women are surrounded by light and look into there phones in labour – hello inhibition! This is not a matter of completely eliminating light and taking away a communication device but rather – having the conversation about the impact on labour and having someone else communicate on their behalf. It is about education for women. And der -turning off as much light as possible! There is even speculation about the impact of blue light on the ‘birth preparation’ phase and that women are constantly in a state of being overstimulated by blue light⁷, information and technology which could in turn be leading to longer gestations and higher rates on induction. And as our light sources become more sophisticated, the wave lengths and intensity change as does its potential for impacting on the body’s natural rhythms.

Yes women are in hospital to have a baby and sometimes people even prepare them to “throw their dignity out the window” before they come in to have a baby. Which I will just add, is so wrong. Midwives try exceptionally hard to maintain and preserve each and every persons dignity – and there are no open windows, your dignity is staying here – with you. Women expect there will be things that may feel odd but accept that we are the care providers and that how we care for them is all part of the process. But having bright lights (outside of an operating theatre) are not a part of promoting normal birth. It’s kind of like you going to work and having to go to the toilet with the lights on and the door open and maybe a person or two coming in to check on you… regularly. Now I ask you, would you –

1. be able to go to the toilet?

2. prefer the lights on or off?

We are in a very interesting time, the very lights we have surrounding us day in day out are evolving too. In an age of constantly changing evidence and of rich and diverse information at our fingertips – let us take a moment to focus on what we have always known anecdotally. That darkness provides women with a level of privacy that a bright space will not. Darkness also has physical benefits and supports the normal progress of labour.

For the love of birth – turn off those bloody lights!

Resources:

1. Olza Fernández, I., Marín Gabriel, M., Malalana Martínez, A., et al (2012), Newborn feeding behaviour depressed by intrapartum oxytocin: a pilot study. Acta Paediatrica, 101: 749-754. doi:10.1111/j.1651-2227.2012.02668.x
2. Aleeca F. Bell, Rosemary White-Traut, Kristin Rankin. (2013). Fetal exposure to synthetic oxytocin and the relationship with prefeeding cues within one hour postbirth. Early Human Development. 89(3)137-143. ISSN 0378-3782. doi.org/10.1016/j.earlhumdev.2012.09.017.
3. Dr Rachel Reed. Midwife Thinking https://midwifethinking.com/why-induction-matters/
4. Wu YH, Zhou JN, Balesar R, et al (2006). Distribution of MT1 melatonin resceptor immunoreactivity in the human hypothalamus and pituitary gland: colocalization of MT1 with vasopressin, oxytocin and CRH. Journal of Comparative Neurology. 499(6):879-910.
5. Sabihi S, Dong SM, Maurer SD, et al. (2017). Oxytocin in the medial prefrontal cortex attenuates anxiety: Anatomical and receptor specificity and mechanisms of action. Neuropharmacology 125:1-2. Doi: 10.2170/physiolosci.RP006208.
6. Kozaki T, Koga S, Toda N, et al (2008). Effects of short wavelength control in polychromatic light sources on nocturnal melatonin secretion. Neuroscience Lett. 439(3):255-259.
7. Odent, M. (2019). The Future of Homo: The Future of Candles. Pp 25-32. World Scientific: Singapore.

Birth trauma, and those who don’t acknowledge it…

***Warning, angry midwife speech. Profanity a plenty.

Birth trauma is a big deal. It is estimated that 6-8% of women experience serious psychological harm potentially resulting in PTSD relating to childbirth trauma (1). We are not just talking about a woman a little freaked out by giving birth. We are talking about serious psychological sequele that can be both short and long term (2). Approximately 3% of women are estimated to exhibit symptoms of post traumatic stress disorder relating to birth which often correlates with postnatal depression (2). Feelings of detachment, extreme fear, flash backs, insomnia, nightmares, agitation, hyper vigilance or loss of interest or enjoyment in life are just some of the things these women will face while trying to raise their new child. This psychological harm can be the effect of the physical birth itself or complications with their baby (2). Birth trauma can impact on a mother’s ability to bond with her child, affect familial and social relationships. In fact evidence suggests that birth trauma can be the catalyst for poor attachment and can cause unique intimate partner relationship challenges which have long reaching effects for mother, child and family (3).

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  Photo by Akshar Dave on Pexels.com

It seems that some health professionals are not as up to date as they should be. Birth trauma is a very real. As a midwife I think that you can understand that from just being there when traumatic events unfold. For god sake WE are traumatised, why wouldn’t the woman be?! Midwives and obstetric doctors (the good ones) recognise this potential and always endeavour to mitigate the potential for further harm through woman centred care and acknowledgement each woman’s experiences. I cared for a woman with known previous birth trauma and was absolutely appalled by the complete dismissal of her previous experience with the words “everyone is stressed in this situation”…. Ah no mate, this is some complex multi layer shit that you clearly have no fucking clue about because IF you did those ridiculous words would not have just leaked out of your mouth that were clearly not connected to a relevantly educated brain!

And yes I am going to go there! You don’t have kids, you don’t have a vagina, have never and will never carry a child in your womb and then literally be prepared to put your life on the line to spare them if you had to. (Ps you don’t need to have a vagina if you have an empathetic bone in your body) YOU have NO IDEA the complex emotions at play when a mother has been faced with trauma around birthing her baby. For women who experience birth trauma it can be so terrifying to face giving birth again regardless of how it happens. Having a baby under intense and traumatic circumstances shares many similarities with rape. Sounds extreme? Stay with me, there is often loss of control, procedures done against your will, often involving your vagina, or cutting open your body, there can be injury, loss of blood, terror, fear of losing your own life or someone you love, shame, failure, defeat. You cannot tell me that one of the most brutal acts against any woman does not share these similarities. It is a massive and growing issue, so why as a health professional caring for pregnant women – don’t you know about this phenomenon? Why won’t you acknowledge her and help her?

You can be a specialist and good at your job but guess what, when I am with woman and caring for her as a midwife – I am a specialist too. I know deeply the cries of a mother in pain both physically and emotionally. I have sat with, held and supported women in times of extreme euphoria and the gutter of sadness. I far from know it all but I am deeply embedded in humanity and can see psychological suffering. You just passed off one of the most horrible experiences of her life like it was nothing more than another day at the office.  And now she is here in front of you, shaking with fear and has not stopped crying since she set foot in this place and you wash your hands of your duty of care that extends beyond the physical.

So I have to ask… what the fuck are you doing here? Is it to fill your pockets? Stroke your ego? When another health professional asks you if you can do anything to help this woman to settle her sky high anxiety so she might be able to enjoy the process of meeting her next baby more than the last time – do it. Or if you wont, tell the woman that you understand she must be so scared and that you are there for her too. Acknowledge that she is NOT everyone else in that moment. She is uniquely herself with her story and experiences.  I have been in quite a few situations where women have been given medication during a caesarean to help overcome extreme fear. This was no different. And don’t you dare use the excuse that you don’t want it to cross the placenta when I have seen your colleagues do it AND you will be prescribing a cocktail of opioids to this breastfeeding mother that will be going in to her breast milk. It’s a cop out.  If that was your wife, your sister, your daughter, your mother – would you watch her suffer? Would you just ignore her crying and shaking? Would you ignore her previous birth and trauma? NO, probably not. This is not a post about advocating for the use of pharmaceutical management of anxiety – far from it. The less we use this kind of stuff  obviously the better. BUT I believe there is a time and a place for everything and we are talking largely about benefits far outweighing the risk. And much more importantly my aim is to discuss that absolute cold dismissal of birth trauma here.

It is our job collectively, as a team to listen to each other and to see each woman and her story. To acknowledge and help them in the best way possible with the tools we have which may be medication, words, presence. Whatever, who cares. Just show UP for her!! Stop talking about your insignificant bullshit, trying to change the subject when she is obviously so scared she can barely hear you over the blood rushing in her ears. Be a carer and care or at the very least trust the judgement of someone who does.

We need to talk about this stuff otherwise we are at risk of losing sight of why we are here and who we are here to protect. The last thing I want anything to do with is creating trauma on top of trauma!

Rant complete. I would love to hear your stories about these kind of experiences, how do you handle them?

1. Howard, L. M., Molyneaux, E., Dennis, C., Rochat, T., Stein, A., & Milgrom, J. (2014). Non-psychotic mental disorders in the perinatal period. The Lancet, 384(9956), 1775-88. doi:http://dx.doi.org/10.1016/S0140-6736(14)61276-9
2. 2. Ayers, S., Bond, R., Bertullies, S., & Wijma, K. (2016). The aetiology of post-traumatic stress following childbirth: A meta-analysis and theoretical framework. Psychological Medicine, 46(6), 1121-1134. doi:http://dx.doi.org/10.1017/S0033291715002706
3. Taghizadeh, Z., Irajpour,A. & Arbabi, M. (2013). Mothers Response to Psychological Birth Trauma: A Qualitative Study. Iranian Red Crescent Medical Journal. 14(10). 1-7. DOI:10.5812/ircmj.10572

The Midwife Birth (not a short version)

I have been thinking about what I wanted to write about this birth on and off since the day it happened. You see, I have written down both of my other births to remember them and to give my children a detailed account of their journey into this world, what it meant and how it felt to become their mother. To me this is an important part of their history and I still enjoy listening to my mother talk about when she birthed me. I can tell you that if there is any connection with how we are birthed and our personality, I am living proof. My friends in midwifery will find it amusing that I was an induction of labour at 39 weeks for suspected intrauterine growth restriction; however I was a healthy term size. I was impatient to get out and get started, I even fooled the doctors. 

The reason that this birth was so unique is that it was not only part of our family history but also a part of my midwifery journey. As I have mentioned in previous blogs, I was not a midwife when I birthed my first and second child. I was just a mother. This time I was a hybrid: a Midmother.

Midmother: Midwife who is also a mother. (Original term, made up by me).

 

Me, 39 weeks. Waiting….

 

What prompted me to sit my softer cushier behind down to write was the sharing of birth experiences with a new friend who had a baby less than two weeks ago. Just talking about our births had emotion welling up inside me at its raw and powerful beauty and of course that universal feeling we were both experiencing at reliving our births. Birth and motherhood connect women, sisters, mothers and daughters, friends and strangers unlike anything else I have experienced.

 

So, let me begin the story with my pregnancy. It was virtually uneventful. A small blip with abdo pain caused by spasming abdominals (happened on night duty – go figure). I felt healthy and well, energetic and my baby was moving and growing. I worked in birth suite right up until the end and each time I was present at a labour or birth I found myself thinking – shit I have to do that again. Now – my previous birth experiences were straight forward and I had gone into labour on my own, laboured well and birthed without any intervention or pain relief. I know this is not for everyone but birth for me was a rite of passage that I regarded as necessary and natural. I also trusted my body without question. By that stage I had only attended one birth aside from my own and I knew nothing of risk or complication. I saw birth through the eyes of a mother passionate about birth. But this time, looking through the eyes of a Midmother, having seen what I have seen, heard what I have heard and read what I have read – it was hard to ignore the ideas of risk and complication. Even though I had a well pregnancy, I found myself having thoughts of cord prolapse, antepartum haemorrhage, undiagnosed breech presentation in labour, losing my baby, so many things! I frequently had to mentally slap myself and snap out of it. Ignorance is bliss really. Not knowing about those things was a blessing when I look back. So approaching the birth of this sweet little darling I would swing between little jolts of panic and long stretches of a deeper sense of trust in my body. I would be walking and trying to picture my birth, which I did a lot with the others and all I could imagine was water, my husband and children. Each time I felt that little bit of fear rising I would whisper to my body and my baby – “I trust you”, little did I know I should have been speaking this to my brain as well.

 

My due date came and went, though I felt ready to give birth from somewhere between 38 and 39 weeks. Up until that point I had busied myself with jobs, socialising, Christmas and so on, so I wasn’t really bothered and felt great. Once I surpassed my longest gestation of 40+3 I began to get emotional and that little silly thought would pop into my head – why haven’t I gone into labour yet? Is there something wrong? I knew very well what advice I would give any woman to reassure her and comfort her while she waited out the final days to meet her new babe. But none of that was comfort coming from me. I needed my midwife! I believed it when she said it when I couldn’t believe myself. So I waited.. and I waited. Every morning, afternoon, evening and night I waited.. I resisted the urge to check my cervix every 5 minutes to see if it had changed even though that in itself was tormenting. I liken it to having a mysterious letter arrive but not being able to open it until someone tells you that you can but you have no idea when that will be. It was maddening for a control freak like me! When I did check my cervix it was so far back it may as well have been hiding near my tonsils and no matter what creative positions I tried to reach it, it just wasn’t happening.

At 40+5 I waddled into my midwife appointment and cried. Yep, I couldn’t hack it already. Part of me felt like a failure because I should be patient. I reassure women that pregnancy up to 42 weeks and beyond is healthy (**conditions apply**) but for me it had become a bit of a mental health war zone. I was jumping from miserable one minute to normal the next. Getting snappy, frustrated and feeling overwhelmed by the heat and then feeling complete normality. Needless to say I opted for a stretch and sweep, but alas nothing happened. 

 

During all of this waiting my husband was mostly at home missing out on work to stay with me “just in case” but really I know he stayed with me because I wasn’t myself. When women go overdue – I now know from experience that you lose part of yourself and simply become – The Pregnant Lady Waiting to Birth. I swear I could write a book on being overdue! It is incredibly taxing physically and emotionally and if I thought I felt compassionate towards women who were overdue before it has NOTHING on what I will have for them now! And to think I only got to 40+10. There are millions of women who have by far surpassed that time – ladies I take my hat off to you all!!!

 

I visited my work and saw one of the doctors and one of the midwives, both of whom I respect and admire greatly just in case I found myself needing to birth there. I made a back up plan to put my mind at ease and went about my business trying to get my baby born. So at 40+7 I saw my midwife who did another stretch and sweep but I didn’t feel it had done much. So… in all of my impatience at one week overdue I took it upon myself to evict the child. Yep, I hit the castor oil. I reacquainted myself with the evidence which by and large states that it can certainly cause nausea, diarrhoea and stomach cramps (yep did that). Evidence also suggests a correlation with castor oil use and meconium stained licquor (MSL), however in cohorts evaluated castor oil was only used in women who were post dates which is a well known risk factor for MSL as the bambinos bowel has reached maturity and is ready for action!  This my friends is not for the faint hearted or bowelled! Yeah it gave me stomach cramps alright and contracted my bowel for the bowel contracting olympics! And finally I got some contractions – yeahhh!! Contractions! I was so eager to feel them that I did with such enthusiasm and a sense of welcome that would put your dearest long lost friends reception to shame. I waddled around my house loving life. Enjoying the building and receding of the waves bringing me to meet my baby. Finally it was happening.

 

My big babies went to bed. I tucked them in feeling calm and ready for the night ahead. But I was also really desiring my own space to let my body find its rhythm. So I ran a warm bath and slid in, enjoying the warm support. My beautiful husband gave me space to get settled but checked in regularly so see if I was ok or if I needed him. Contractions got stronger and closer over the hour. Not incredibly intense but definitely closer together. They had gone gradually from 7 minutes apart to 2 minutes apart but I wasn’t sold. I started to get a little shaky, mostly I think because I was nervous and I had my doubts about whether it was really labour. BUT after having a 2hr labour with my son and nearly not making it to the hospital I called my midwife for advice. She had been my midwife for my last baby and said I should come in.

 

So come in we did. We packed the kids into the car at some time near midnight and as we drove away from our home all I could think was, I hope I haven’t come in too soon. My daughter was so excited she stayed awake for the car trip and my son fell straight back to sleep. My contractions slowed during the car trip but I thought, its ok I just need to get re-established, bambi doesn’t birth next to a lion – or a dolphin next to jaws. I just had to settle in and get my mojo back. We were welcomed by my sweet and humble midwife into to the space I had pictured. It was perfectly quiet with just enough light to see what needed to be seen.

 

We settled the kids back to a restful place where little man fell asleep almost instantly. But my little woman kept a watchful eye on me for a little while before she found sleep again. And I paced the floor slowly listening to my music, waiting for each contraction to come. And they did but they got further and further apart. What changed however was my contractions. Even though they got further apart they started to become excruciating. I rested very little and as a result became dry, exhausted and defeated. I managed about 20 minutes rest because if I laid down I would contract and have to jump out of bed with the intense pain I felt down low right above my pubic bone. I wanted to cry – which I did! And I wanted to go home and sleep. My midwife was so encouraging and sweet telling me that sometimes third babies get stuck, lost, tricky or all three. But basically to expect the unexpected and to surrender. I found it hard to reconcile what had happened with not having a baby. And I was also having a hard time computing that though my contractions were few and far between, but had become so painful! The midwife had thoroughly taken over and started dominating my thoughts. My midwife checked and I was 3 or 4 cm and 75% effaced, I think. Maybe. It has been a while but there certainly wasn’t a baby coming out, so we packed up our kids, our stuff and went home. I was so deflated that day and in desperate need of rest. How on earth could a midwife get it so wrong I had wondered?! Because she is a human, and a mother, but I didn’t listen to that advice that day either! My midwife told me she would see me that night and I would have my baby. I really wanted to believe her.

 

I trudged home and slept in my bed with the love of my life and my big kids quietly amusing themselves. I honestly barely saw my husband eat, drink or even go to the toilet for the next 48 hours. He didn’t leave me and he kept me as together as possible in the state that I was. I continued to contract irregularly but painfully. I realised after some time that the intense pain was my baby moving with the contraction causing my womb to feel like it might split in two. So we pottered around waiting, eating, resting, walking, cuddling my kids. It was a long day on the back of very little sleep. My contractions became more frequent by the end of the day so that by 5pm they were every 10 minutes. Mild but regular. The crazy baby moving pain had settled down by then thank goodness! The contractions stayed much the same and I told my husband I was going to bed, saying something to the effect of – hopefully I can get some sleep before they get stronger. And I started to walk through my bedroom to the ensuite to pee, when I felt a little pop and a warm wet sensation I knew was not pee. Half terrified and half amused. I knew there was no turning back now and that I was on the clock. Hoping with every fibre of my being that my midwife was right I called to let her know I had SROM’d, it was nice and clear and headed to bed awaiting my painful wake up call of duty.

 

Wake up I did, every 10 minutes all night long with exactly the same contractions I had had since 5pm the night before. At 6am I dozed between contractions sitting up in bed. Absolutely no change. I knew that if this kept up I would not be able to birth my baby at the birth centre and started to get nervous. The fluid was still clear but I went to get assessed to make sure everything was ok. Baby was moving well and I felt otherwise ok if not tired. Baby and I were fine and one of the midwives told me to get moving. So I did. Broken waters and all, I hauled ass with the whole family to a beach with walking tracks notoriously steep and arduous. And walk I did, over mountain (just one) trying to get this baby out gushing fluid like there was no tomorrow. It was the most gross, wet, unsuccessful venture ever. All I kept saying was I’m leaking, I’m leaking can you see any fluid?!! To my poor husband who did his best to placate my concerns. But the walk did little to help my contractions. I did nipple stimulation until they nearly wore off – nothing! I rubbed birthing oil into pressure points and everywhere else for good measure – still nothing more than the odd and again excruciatingly painful contractions.

 

Finally I got home, went to change my industrial sized pad and found… mec. Yep clear fluid had changed a light yellowish green. Had I not been a midmother I would have said yellow. But being who I am and doing what I do, I knew. So I called my midwife and she asked if I would be ok to go to my work to which I replied of course. I called the beautiful doctor I had spoken to just 2 days before who asked me if I was ready to have my baby to which I replied yes. Finally, I called my midwife from work who also happens to be a dear friend and asked her if she would help me have my baby today. Gosh, even writing this evokes so much emotion I can barely see the keyboard. She told me yes, of course and that she would be ready for me when I got there. I had been walking, talking, moving, eating, organizing and thinking since my brain fluttered awake that day. And after I hung up from all of those calls I cried. I burst out ugly cried, mostly out of relief. I was actually going to have a baby after all. Oh, that’s right, my baby.

 

This birth had warped and changed in my mind so much I no longer knew what it was going to be anymore. So, with tears in my eyes and my children’s hands in mine I explained that I needed to go to my work to get help to have their little brother or sister. I told them it was bound to be different to how we had talked about it and would they be okay if just Mum and Dad went and as soon as baby is here they could come and meet them. Even though they had been so eager to come and not miss out, the three days of stop start and trekking around had worn them out too so they gave me their leave. My parents, who are always there should I need them, came over immediately so we could go and have this baby. The hug from mum before I left was just what I needed. I cry snort laughed and she cried too. We kissed our kids goodbye and told them we would call them straight away when it was all done. And Carlos bundled me into the car to finally birth this baby.

 

My midwife had my room beautifully set up. It smelled and sounded amazing. She settled us in and gave us some space to get used to the room. I couldn’t help cleaning and moving things because I was also in my workplace after all. But my husband soon put a stop to that. Soon after we got ready to start the oxytocin infusion, but I was eager to know what the hell all of those contractions had been doing. My midwife checked and I was 5cm and fully effaced just sitting there not doing a lot. She said that she thought perhaps baby’s head was deflexed which could have been a cause for this long introduction to labour. I put my music on and as my contractions restarted, I got in my zone. I had my husband right in front of me to lean on, swaying with my tunes and opening up my hips. I felt so calm and relaxed knowing I was finally there and my contractions were not stopping. I had been on the jungle juice for somewhere near an hour having good regular contractions but I knew I needed a little bit more power. So we turned it up. The contractions really stepped it up a notch then, and all I could see during contractions was the darkness of my closed eyes. I started to feel overwhelmed and my breath would catch. At that point I knew I must be close because these contractions were unbelievably strong! Reminded to breathe I recentred, hoping that there wouldn’t be too many more of these ones. I think I had about 4 or 5 of the kill me now or give me an epidural contractions when I felt a sudden change. It was like I felt my cervix finally give up the fight and I felt my baby move down a smidgen. And over the next contractions I felt the urge to push giving way to the pain. Ever, so, sloooowly. I wondered if I had my information wrong, so I felt inside and there is was. That head with the skin all squishy over the skull. I couldn’t believe it. But it was happening. I started pushing stronger as the urge came and when I got that pressure in my bowel all I could think was oh no, im gonna poo on my friend or near her, but she wont mind right? haha But try as I might it was all I could think of until I said it out loud to receive a chorus of two midwives and my husband telling me to stop being silly and have a baby. So I did. I finally let the force fully awaken and poo I sure did! But to my astonishment, my friend had some tricky talents in poo origami where she folded it in a towel never to be seen again. I’m keeping that one in the bank! Then it happened, the ring of fire I had to carefully pass through before meeting my baby, that white hot blade of a knife that you stand on with tip toes not daring to move in case you slip and cut your whole leg off! My midwife slowing  me and guiding me with her words. As my baby came through I felt my calf muscles jerk my legs onto tip toe as I roared my baby out. After this little slippery being came out I reached down and pulled it up to my belly with complete satisfaction. Nothing exists in that beat of the heart but gratitude that it is done. The extraordinary pain and power is over.

 

I was overwhelmed with excitement to learn who this was, as it was out first mystery gender. I looked down to see what we had had, and much to my surprise and delight I saw a tiny little vagina heralding the entrance of a baby girl! That burst of complete love and joy so sincere it makes me blubber at the thought. There could have been anything happening in that room and I would have missed it as all I could see was her and him. Two of my four people, forever. There are no other experiences in life that are like having a baby. I was utterly euphoric and so in love my heart could burst. If I could harness and bottle what I feel when I have a baby, I would most certainly be addicted. Within minutes all I could think of was my kids at home waiting for news and I wanted them to be with us as soon as possible. My husband made the call not revealing the sex until they arrived. And when they did, it was one of the sweetest things to see. Being a little older the emotion was so big and mighty my son was moved to tears and my daughter just blown away. And naturally my parents overjoyed to welcome another grandbaby. But my husband, the man I chose for so many reasons looked at me with such a sense of love, respect and adoration. He had been by my side through all of this, and never left. He looked at me in ways I cannot explain but showed how grateful he was to me for giving birth to our children. If I could bottle that too, I would.

 

We all fell madly in love with the little blossom and still are very much in love with her and each other.

 

Here is the prize, in the arms of her big sister only a couple of days old.

 

Sadly I wont be birthing again, but I am so lucky to be able to say that I will attend birth for many years to come. I fully recognise the moments in time that I will be present for, that truly change the world(s) one baby at a time.

 

Gee whiz that was lengthy! I hope you enjoyed reading it as much as I enjoyed writing it.

 

Love The Moderate Midwife xo

 

 

Don’t ever forget what you are a part of.

I am resurfacing after a lengthy blogging hiatus. I recently gave birth to a wondrous, loud, small, bossy, sweet, perfect, all consuming and beloved daughter. And with this whole incredible experience (my first time as a midwife), I have so many thoughts and feelings new and old to share. To sit for a while on the other side of this midwifery gig is really quite eye opening. To reconnect with myself as a mother/birth giver has meant I have reconnected with my line of work in a whole new way.

Let us cast back to before I became a midwife, seven and nine years ago. I was a young mind and body of 21. I was invincible and infinitely trusting of my body, baby and of birth. I knew nothing of bad outcomes or deviations from normal. I believed that we are born to birth babies, that we are powerful, incredible beings! And subsequently, or so I believed – I had these two fantastic births, very different but healthy normal labours and births. And I thought the world of my midwives. Especially when I was in the caseload program the second time. I had two midwives, both incredibly kind, insightful, knowledgeable. And they were mine! I felt so lucky and so safe and just thought they were the bees knees. I still do!

Now that I am a midwife, I have walked on both side of the fence and one thing that really stands out for me recently becoming a mother again. I say that because I believe that each time you have a baby you become a mother again. It is new for you and your baby all over again no matter how many babies you have because each bond and connection you have is unique. But I digress, the thing that stands out is what I had forgotten.

The life event that is, having a baby.

Time is a wonderful thing, it gives you insight, clarity, experience and it heals. But there is another thing time does – it lets you forget. As a mother I remember what it felt like to be pregnant, bring a baby home, to muddle through those first weeks together trying to work the new person out and into our family. But as a midwife, I forgot what a crazy heart stoppingly beautiful, intense and raw experience having a baby is. I think that being a midwife, you know what you do is awesome, you love your job for all its beauty and you take all the shit parts because its worth it. But, it can be pretty chaotic, stressful, papwerworky and is often wound up in policies and guidelines causing a level of disconnect from the magic. Each time a baby is born you get that wonderful burst of happiness and oxytocin with the family but all too soon you are drawn away to do the “job” that is being a midwife like cleaning up and paperwork and observations la la la you know the drill. You get the snapshots of pure bliss that punctuate the hard, physical, mental and emotional work that you do day in and day out. Since working as a midwife I have rarely cried at births. I usually shed a few tears of happiness on my way home from work when I get to reflect back on the births that were.

 

But for that woman, that family – their entire world shifts in a new direction in that moment. That moment that you shared with them is etched forever into their history. Your voice in their ear ensuring their confidence. That joke you made or that toast and tea you delivered as she nursed her baby soon after the birth. When I finally got out of my midwife head and was wholly and solely a mother and met my new baby I thought that my heart could have burst. The hours to follow are intimate and special. You feel tender and vulnerable but also amazed and powerful. I entered a bubble of complete happiness and had this perfect baby to stare at that me and my chosen one made from scratch. How amazing that is, cannot be put into words. It is impossible to capture it accurately.

 

Midwives came and went, doing their duties, obs, paperwork and asking obligatory questions about who’s weeing and pooing at what not, but I was just sitting there off my face on oxytocin staring at my sleeping beauty. Feeling all of those feelings again so powerfully just makes me want to remind midwives – remember what you are a part of! Even if you are having a bad shift, steal a little bit of the sunshine that is having a baby. These women and families we care for just had a human! Someone who will be part of their lives as long as they live and beyond.  Each time you walk into that room, soak in the specialness (probably not a word but I’m digging it). There are so many jobs, so many that are motivated by targets and money (I know, I used to do them!). We have a job that focusses on what can be one of the most sacred, beautiful, challenging and memorable events in a persons life! I feel a renewed sense of love and gratitude for my job as a midwife. After giving birth again and truly feeling its specialness (yes, again I like it), I cannot believe I get to walk into those rooms and care for women and their families. I feel so excited to go back to work even though that is many months away – when I do, I hope I haven’t forgotten what this feels like. And I am so grateful to the midwives that made me feel like this time was the most amazing gift of all, clearly you midwives haven’t forgotten like I had.

 

Love MM xx

PS coming soon, My Midwife Birth 🙂

Times when it is appropriate to comment on a pregnant lady’s weight in general conversation – Oh wait there isn’t one (idiot).

Hello to the land of bloggery. I have missed you!

It has been a while, a long while indeed since I have given the keyboard a thrashing over something I feel intensely about, so I hope my inexperienced rant doesn’t disappoint.

 

This moderate midwife is thoroughly pregnant. Yep – I decided to risk my vagina once more to meet yet another apple of my eye, love of my life, peanut to my butter etc etc. I, no WE are all thrilled. All seven of us, the humans, the fur humans (dogs) and one turtle. It is such an exciting time and I am grateful so far to have had a well and uneventful pregnancy, aside from some rather clumsy, dopey and pregmotional moments that is. But of course this is completely normal behaviour… of that I am certain.

 

But, I will delay no more in my bid to get off my chest what has infuriated me this pregnancy, and the last and the one before that. In fact, it has infuriated during other people’s pregnancies when they have brought it up with me. My response is always very expletive and full of fiery outrage.

 

Which brings me to my solid nugget of advice for anyone who will listen – don’t call the pregnant lady fat, or any variation of it.

For some of you this may come as a shock, but yes, some mindless people actually think it is amusing to joke around calling a pregnant lady fat. I shit you not, my own local grocer whom I very much like greets my pregnant self with “G’Day Fatty”. In my Nina Proudman mind I am launching a full can of coconut milk directly and his poorly proportioned nose attached to his gigantic bald head that I never bring attention to for fear of hurting his feelings. The same courtesy is not extended to me.

 

What the hell is wrong with people? As soon as a woman becomes pregnant, or has begun sharing her exciting news – the weight comments start rolling in. “Oh yes I have noticed your boobs have grown cause you sure didn’t have any before har har fucking har!”, or this was my favourite and most memorable from my first pregnancy (yes, I remember nearly ALL of them) – ME: I haven’t really put on any weight, I don’t think I even look pregnant. PRAYING MANTIS COLLEAGUE: Oh yeah you have, its all on your bum. As pregnancy progresses I feel as though I am like a moving target for size related conversation. “Geez you have popped right out haven’t you!”, “You’re huge already, how many weeks to go?”

 

Yes, please tell me more about how you are an expert in my bodily changes..

 

 

It’s actually so upsetting. I try hard inside and outside of pregnancy to maintain a healthy weight by eating well with a balanced diet (everything in moderation including treats) and doing regular exercise. I drink plenty of water and take vitamins and am doing a pretty good job of taking care of my temple. But, for some reason whilst I should be all ethereal goddess and gently learning to love my rapidly growing curves – this constant slamming about what other people think of how I look really gets me down. I know I am not alone in this feeling. Pregnancy is a beautiful time of growth and change but lets face it, your body changes very quickly and in strange and unexpected ways. In any other time of life it would be uncomfortable and unwelcome to gain 10-15kilograms or more within a 9 month period. Why should pregnant women have to suffer the torment of their own body image issues let alone those of every other person who feels the need to comment? For some reason people think it’s their god given right to comment on them. Why is that? I have never said to a pregnant woman or any other woman for that matter – gee you’re getting big, or you look like you’re having twins or even you’re not very big at all are you sure your baby is growing?

 

What a woman should be told when pregnant if anything is said at all is that her body is amazing for carrying and growing a baby, that’s it. If you must elaborate, tell her how healthy her skin looks or how nice her hair is, she is a woman – trust me she already knows her flaws far better than you do!

 

I fantasize about a messed up role reversal revolution where pregmotional women can blame their state of pregnancy for witty unkind retorts when they get these kind of comments like; “yes I sure am getting big, but I have also noticed you have been packing on the weight like you’re stockpiling cheeseburgers in your body in case of the apocalypse Bob – at least I have an excuse” or “No Betty I am not having twins, there is only one baby in there – but your perm looks terrible you need to consider changing hairdresser”. An eye for an eye! But of course, nobody does that or would do that because they are too busy dealing with the shock of the initial comment and how they look to address the person appropriately. They just store it inside themselves until the next time they see a close friend, or a midwife. Women complain about it all the time and I am suitably outraged with them! I tell them to tell whoever hassles them that their baby is measuring perfectly and that they too are healthy and should mind their business.

 

So, if you are one of those people who think it’s funny or appropriate to comment on the weight or appearance of a pregnant woman’s body – STOP. Swallow your shallow, shitty and unhelpful words and reserve that criticism for the mirror. If you are prepared to dish our comments on how women look at what can be one of the most vulnerable times in their life then you should be happy to receive them back yourself. You don’t get to be the person who makes us feel silly for not taking these comments on the chin either, they are not appropriate at any other time in life so pregnancy is off limits too.

 

We don’t all feel like round goddesses, it would be wonderful if we did. It has taken me the majority of my pregnancy to finally feel at home in this body and it’s nearly time to push this baby into the world! I absolutely adore pregnancy, I am one of the lucky ones – hence the midwifery career. But I can whole heartedly appreciate the disappointment, shame, guilt and irritation of these comments bring about and I find them so rude and unnecessary.

 

If you have experienced witnessed or part taken in this frequent kind of behaviour and are looking for a way to atone your sins – share this post so that you can prevent further pregnant woman abuse.

 

Much love, the very pregnant Moderate Midwife xo

Two halves should make a whole instead of two sides to make an argument..

I had a lengthy debate on night duty the night before last, a frank exchange of words and honest disagreement with an obstetric doctor about water birth. Ever since I have been coming up with the best one liners and examples of evidence that has failed women in obstetrics over the years. The Term Breech Trial¹ which used all women regardless of risk, dramatically increasing the caesarean section rate almost overnight,  early studies on post partum haemorrhage that again threw everyone in the same bucket regardless of risk, Freidman’s curve² that pigeon holed women into progress expectations that were unrealistic and eventually re-evaluated etc.. And I literally sit here pounding at the keyboard in a mood that leaves my humour a little sidelined from the usual.

 

I’m sorry guys I don’t know if I can make his one funny, it’s a passion post and not of the heartfelt kind. It’s the fire in your belly, make you grit your teeth kind of frustration that keeps rearing its ugly head in the back of your mind as you think and think and think about it. (Sorry keyboard you are really copping it today).

This is me all Lioness today – Roooaaarr!

This essentially professional debate about water birth really highlighted the difference between some obstetrically minded and midwifery minded people and that VERY unfortunately for some, there is no overlap. Obstetrically minded people can be midwives and they can be doctors, they can be people off the street. Obstetrically minded people have an ability to completely cut off the human that is having the experience. They are able to quantify everything in their mind based on statistics and measure success in morbidity and mortality. There is little regard for the person who is giving birth, their feelings, their fears, their sense of self, their support people. It’s all just black and white. On this occasion, a person readily dismissed waterbirth as a safe option for birthing due to poor outcomes allegedly caused by waterbirth although there is no definite proof of cause. The evidence was an admission to special care nursery with respiratory distress following waterbirth.  Babies are often admitted to special care nursery for observation with signs of respiratory distress due to an array of other reasons, like caesarean section, prolonged seconds stage, prematurity, just to name a couple. This cannot be the sole reason for concern and it cannot be pinned to waterbirth or dry land birth.

 

What this obstetrically minded person was trying to convince me of was that water birth is not safe and that we are not telling women the truth about it. I nearly fell off my chair! She based this assumption on four outcomes, which frankly is ridiculous. As we are all trained to know that evidence considered to be rigorous DOES NOT COME FROM A SAMPLE OF FOUR!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! Sadly in the birthing world there is an unexplained phenomenon that sometimes gathers obstetric events of similar nature together, be it PPH’s, third degree tears, premature labour etc. You simply cannot call a way of birthing into question based on four cases. I am not saying this phenomenon is the reason but it could be and that statement holds about as much statistical value as the statement that all water births are unsafe because of four cases. Risk is everywhere, sadly just because you do not have a water birth does not mean that you will avoid a negative outcome. Equally, just because there is risk does not mean you will not have a straight forward, beautiful, empowered birth.

Which brings me to my next point, statistics are generated to test hypotheses. However statistical analysis is an art and we all know, as with painting and photography that not everyone can do it. How many “studies” have you heard of lately that have been overturned due to incorrectly interpreted data or even that they had fabricated the data altogether? Fact is only fact for a moment in time and then another person comes along, tests a hypothesis which makes us all question what we thought we knew. I am not saying that evidence is not used for good reason, it is important part of guiding our practice, but it must be rigorously tested for currency and validity. What I am highlighting about evidence today is that it is temporary. Another important fact that I will highlight here is that you can gear research to fit a desired opinion. Anyone who has studied at a tertiary level and has written a persuasive piece can attest to this. There will usually be two sides of an argument with evidence to support each one. If you are lucky you will find literature reviews that compare and contrast the evidence and  attempt a balanced review. And if you are open minded enough it may even change your view and create a more balanced overview.  But if you are not, you can use your carefully selected evidence to frighten people when it is delivered in the right way to completely alienate them from their desires and make them have the birth YOU consider to be “safe”.

Also referred to as coercion or intimidation.

Now back to these obstetrically and midwifery minded people.

In an ideal world we would both cross over and share ideas with respect for each other’s professional experience and insight. Midwives being specialists in normal birth and obstetric doctors being specialists in the abnormal birth. Often this happens in practice. Some of the most woman centered and professional team members within maternity workplace are engaged in sharing information to assist each other instead of judging or criticizing. However, in my observation of obstetrically minded people it is very much an “us and them” way of thinking that leaves the midwives feeling as though they are worthless and redundant, as though their years of training and experiences amount to nothing once that person walks in to the room. I dare say there are few things that can be more poisonous to a midwife and birthing woman.

 

Midwives from my own experience and the many that I have watched who are true midwives, not doctors assistants, have access to things that obstetrically minded people will never see. They are not privy to a world of safety and wholesomeness surrounding birth. Midwives will prioritize putting a woman first, her baby as part of that whole, the two are not separate. When you care for the mother that includes the little person inside her. We appreciate and understand that birth is not just about morbidity and mortality. It is an unforgettable life experience that she will tell her daughter about when she is having her own children. The birth of a baby is a moment in time that is beautiful. Midwives appreciate that, they take care of the medical side of care but they also connect with the feelings as an important part of their business. They create lasting professional relationships. They see the woman as an identity that is multifaceted, complex and enduring – she is not just a statistic, not a machine. Midwives value choice, empowerment and satisfaction as important parts of pregnancy, labour, birth and new motherhood.

Being the moderate midwife, as I have said before, I am not right wing or left wing. I sit in the middle. I sit beside the woman because she is the one who is in the middle, with her baby. Obstetrically minded people and midwifery minded people should be able to openly converse without mistrust of each other and be open to a change of mindset or at least develop more balanced perception. We need a mutual appreciation for our differences and come together to really hear each other. We are both en route to the same hospitals for the same reasons although you’re driving your Mercedes and I’m in my Mazda, we may take different directions but we end up at the same place. We both want healthy mothers and babies, but that means different things for both of us. We take care of normal, holistically and intuitively and when it becomes more complicated, we engage your help. We are educated, safe, sensible people caring for women who need it. We read evidence too, but we apply it to real life human beings instead of mechanical devices who need to be considered without piling fear on top of them preparing them for adversity they may have avoided without your poisonous words.

 

Ultimately we are all humans helping humans do human things. Perhaps getting off that large stallion will help you to gain a more human perspective.

OK one funny…

 

And of course, I hold great respect for the obstetric doctors who I call my colleagues that are equally midwifery and obstetrically minded. Thank you for valuing the woman in a culture that doesn’t say that you have to. It is a gift and deeply valued by the women you care for and the midwives who care for them.

 

The Moderate Midwife.

 

Sigh, that’s a little better, but I’m sure there will be more on this.

 

 

1. Hannah M, et al. (2000) Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial. Lancet; 356(9239):1375-1383.

 

2. Friedman EA 1955, Primigravid labor: a graphicostatistical analysis, Obstetrics and Gynecology, vol. 6, no. 6, pp.567-89.

Memo to the women of the world: we don’t really see your vagina..

I think there is a drastic misconception about midwives. This comes from the very private nature of birth giving and the intimate space and time we share with women. Often women say things to me like, “well you’ve seen everything”, “when you come to have a baby, your dignity flies out the window”. This couldn’t be further from the truth. And because we midwives spend a lot of time around naked women pushing babies out of their incredible bodies, I get the idea that they feel like we analyze or remember their anatomy. I once cared for a woman that I later became friends with through our children going to the same school. Long after her birth I noticed a tattoo on her leg and said, “that is a nice tattoo”, to which she replied something like “didn’t you notice that when I was having my baby”. Uh, no I didn’t. I was kind of busy listening to your baby’s heart beat and keeping your birth space all zen, and checking the birth pool temp and writing bloody notes to see that.

 

 

When you enter the world of birthing as a mother your vagina does not have a memorable identity. Unless it has its own speakers, flashing lights or is covered in vajazzle bling we don’t see it.

I would remember this.. so would your baby!

 

I know that might sound a little bit silly. But its true, ask any midwife! Unless she is a bonified, qualified yoni massage therapist/warrior, she see’s a birth canal with a cervix inside it. She sees layers of skin and muscle. She see’s an amazing organ, all of which are unique, but ultimately the same. I mean yes, I see vagina’s all of the time but I pay no attention to what they actually look like. Whenever a woman has requested or consented to a check of her cervix, a stretch and sweep, needs a speculum to check if her waters have broken etc etc etc Midwives and Doctors alike perform such tasks without even registering the vagina very much at all.

 

And i guess you might be wondering why exactly I am making a point of telling you this?

To give all of you ladies back the privacy you deserve. Yes birth can make you feel like you are naked and flapping about in the breeze on the top of a hill in the middle of a supermarket the day before the Easter long weekend. But there just is no need for that! Because even though you’re naked birth giving body is there, we ain’t lookin! Sure we see the basics, but we certainly don’t spend a single second pondering on the details of your labia, or your butt or your breasts, let alone remember them. I believe that comes down to the fact that we see soooo many, we are very accustomed to celebrating diversity and caring for women. And many of us are women.

 

Now, don’t interpret this as meaning that I don’t have 200% R.E.S.P.E.C.T for the vadge – I do. And then some! That tiny little key hole is capable of amazing things! And if you expected a midwife to love an honor the vagina, we most certainly do – however we don’t need to stare at, analyze or remember each one to do that.

So if you have given birth, are going to give birth or want to give birth one day just remember – we don’t see you as your naked individual, sometimes self conscious (in a good way) and private self. We just see a woman giving birth, we listen to her baby’s little heart beat and we keep that birth space all zen while writing notes and caring for you on the day your life changes for ever.

 

Big Love from The Moderate Midwife xxoo

Birth Synchronicity

This post I write in my undies after a couple hours of sleep before night duty. All pasty mouthed and blurry eyed, because I am a classy lady! (Hah) I have been laying in my bed somewhere in between sleep and rest with so many thoughts popping up and have been thinking about one thing in particular. As I have mentioned before I am a raging overthinker. I sometimes wonder just how many extra thoughts I have for other people’s one. Sometimes its annoying but other times i really feel like my excessive thoughts lead to something meaningful. For me anyway…

So, an emotion or feeling that I came across is what motivated me to ponder about the idea of birth and synchronicity. It was actually my own insecurity about caring for women in my own unique way that made me think hard about what I believe. Midwives, nurses and doctors are all so different. Each of us bring so much with us when we go to work. We bring our knowledge, experience, beliefs and personality. We bring all of that and then mix it in with the soup of the working environment with other people’s stuff. And we kind of have to do that be cause we work in a team.

Now to give you some context around my thoughts. I was talking with someone who has recently done some learning about Calm Birth which I think is wonderful. I don’t need to go into excessive detail about what I think about calm birthing techniques here other than the fact that they can be incredibly helpful for some women and partners while they are completely intuitive for others. I will say that I believe when anyone works as a midwife and goes to lengths to learn information to help women and their support people to understand how to support their body labour, believe in it and treat it as a positive experience – it is an excellent thing! BUT, and there is a but here. When it causes that person to feel and or project that he or she is more skilled in attending birth I begin to feel uncomfortable. And that may all be a concoction of my own imagination, but a transaction of a few key words made me feel and think about my presence in birth and what I bring.

 

I have done a lot of reading and research about psychophysiology or normal labour and birth throughout my degree and now throughout my masters. I know what promotes the surges of oxytocin needed to create powerful contractions and I know what doesn’t. I know the impact of good hydration and positive association with intense contractions. I know the power of touch, massage, acupressure points to relieve pain, decrease stress and intensify contractions. I understand the importance of darkness and privacy, but also of love and presence. I have read loads of different perspectives and dozens of articles about the scientific basis behind creating and protecting birth territory. But with a couple of words of another I will quickly cast doubt over everything I know both through learning and my own experience as a woman.  Just, for a moment.

 

And this brings me to birth synchronicity.. and why NONE of that shit matters!

 

There are millions of midwives around the world who haven’t learnt about any of the stuff I just talked about. But they show up for women every day and they act with integrity, alertness, compassion and love. They bring their knowledge, their experience, their personality and beliefs. Just as each woman brings all of her own. Midwives may attend birth with silence and gentle touch or they may have a hearty laugh and keep people at ease. But they are there and they are meant to be. Midwives and women connect in equality and in each moment when they are together it is something a little bit magical.

 

I get reminded of birth synchronicity all of the time. I don’t know how many times I have known in my heart I would see a woman again and then it happened. Or someone comes in, in labour and tells me that they were hoping they would see me. It is just as it is – you get who you need when you need them. Like the universe has already worked it out any we are catching up. And I believe it goes both ways, for women and midwives. When we need a soul nourishing birth or to learn something new that is what we get.

So no matter who you are as a midwife, soft and gently spoken or loud and a little nutty. Don’t worry, the universe chose you for that woman on that day. Be yourself and be completely present with her and her family in whatever shape that takes.

Love always,

The Moderate Midwife.

Postnatal War (d)

I started write this post on the back of two shitty shifts. And having been in the middle of an NPH (non partum haemorrhage). So yes perhaps I was a little fragile but I was so emotionally and mentally wiped out AND heartily reflective so I started writing.

 

I am still trying my heart out to be the best midwife I can be, all choked up just writing that sentence. But on the postnatal ward, when it is busy I find it incredibly hard. From the moment you arrive onto the ward on a busy shift its overwhelming. Staff  who have been busy all day are  stressed and exhausted and hungry. There are lots of people with different stories and experiences, some okay and some terrible. Some women are well and some you are concerned about. But they all need you, that’s why they are there. So in amidst the chaos you have to get handover which except for the basics can be like frigging Chinese whispers unless you read the notes – which on a busy shift is very hard to do. Scratch that – impossible! And I would like to add that this is nobody’s fault when it is busy – its just how it is. It’s like a little mini war zone with sore women and hungry small humans and frantic midwives trying to patch holes in the pipework.

 

And on those days no matter how fast and effectively I try to manage my workload while still trying to be available and attentive to each woman – by the end of the shift, when handing over it sounds like I have done nothing. Which is never true, I work hard. I was brought up by two people who did little else so its natural for me to get in there and get stuff done. But the war zone does nothing for your confidence as a toddler midwife and I can tell you sometimes I feel like throwing ALL of my toys out of the cot, stamping my foot and scream crying until I wear myself out and go to sleep haha. But like a good employee I usually wait until I’m in the car at least or better yet, when I get home to my husband.

 

But on the postnatal ward there are these experienced amazing midwives who bustle around barely breaking a sweat while I’m scratching in my pocket for my handover sheet trying to get my bearings looking (I fear) confused and bewildered. They are all so calm even when its a crazy ass war zone with rapid responses and clinical reviews left right and center. Their hair perfect accompanied by their lovely gestures and those magical words they say “what can I do to help you”…. Oh. Shit. I’m Busted! They can see by the flailing arms, frizzy hair, the higher pitched voice and furrowed brows that maybe, just maybe I am not cut out for this.. I am an imposter.

Yeah I am a midwife I swear!

I know they genuinely want to help, but its hard to let go of the workload. For me its somewhat like admitting defeat which is horrendously stupid because we work in teams! But I know that they have had a busy workload too and managed just fine. So here I am refining my postnatal ward time management skills. Bettering my self and trying new things to help me keep my shit together when it feels as though the wheels are coming off.

So I’ve come up with a few rules for myself.

1. When it starts to feel crazy, take a deep breath and imagine my hair looking pristine at the end of the shift.
2. Write a task list of stuff to be done for each woman and baby so that if shit hits the fan and one of those magical mystical fairy midwives asks me how they can help – I can hand them my list.
3. Talk in long slow sentences (like Billie Proudman from Offspring when she was trying to stay calm in her efforts to grow a child) to avoid sounding hysterical.

I’m sure these are fail safe. I am set!

I manage just fine when its not hectic. I love it, I get all my work done giving max care and attention to all of the women and babies in my care. My hair stays in order and I shuffle around with a big smile on my dial, cracking jokes and singing down the ward. That’s the midwife I want to be all the time.

Wish me luck, I will be sure to let you know how my new rules work out.

 

Loads of love and more posts to come after a quiet spell, The Moderate (cough) Midwife xx